Healthcare Provider Details

I. General information

NPI: 1386517407
Provider Name (Legal Business Name): KOINONIA DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 CORK COLD SPRINGS RD
GENEVA OH
44041-9346
US

IV. Provider business mailing address

6810 CORK COLD SPRINGS RD
GENEVA OH
44041-9346
US

V. Phone/Fax

Practice location:
  • Phone: 440-207-0629
  • Fax:
Mailing address:
  • Phone: 440-207-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: ANGELINA GILL
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 440-207-0609